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Lambert-Cheatham NA, Tessema ST, Subei O, Sakuru RC, Fullmer MD, Selner EM, Vidal-Folch N, Chang HT, Hasadsri L, Kaufman DI. Predicting Prognosis in CPEO With mtDNA Deletions: A Case Demonstrating the Advantages of Measuring Heteroplasmy With Novel Droplet Digital Polymerase Chain Reaction Testing. J Neuroophthalmol 2023; 43:e260-e263. [PMID: 35483062 DOI: 10.1097/wno.0000000000001555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Nathan A Lambert-Cheatham
- Department of Neurology and Ophthalmology (NL-C, ST, RCS, HTC, DK), Michigan State University, East Lansing, Michigan; Department of Neurology, Banner Neuroscience Institute (OS), University of Arizona, Phoenix, Arizona; Department of Ophthalmology (MF), Beaumont Hospital, Taylor, Michigan; Department of Pathology (HTC), Sparrow Health System, Lansing, Michigan; and Department of Laboratory Medicine and Pathology (ES, NV-F, and LH), Genomics Laboratory, Mayo Clinic, Rochester, Minnesota
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Siri B, D'Alessandro A, Maiorana A, Porzio O, Ravà L, Dionisi-Vici C, Cappa M, Martinelli D. Adrenocortical function in patients with Single Large Scale Mitochondrial DNA Deletions: a retrospective single centre cohort study. Eur J Endocrinol 2023; 189:485-494. [PMID: 37815532 DOI: 10.1093/ejendo/lvad137] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 08/11/2023] [Accepted: 08/16/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE Single Large Scale Mitochondrial DNA Deletions (SLSMDs), Pearson Syndrome (PS) and Kearns-Sayre Syndrome (KSS), are systemic diseases with multiple endocrine abnormalities. The adrenocortical function has not been systematically investigated with a few anecdotal reports of overt adrenal insufficiency (AI). The study aimed to assess the adrenocortical function in a large cohort of SLSMDs. DESIGN AND METHODS A retrospective monocentric longitudinal study involved a cohort of 18 SLSMDs patients. Adrenocortical function was evaluated by baseline adrenocorticotrophic hormone (ACTH) and cortisol measurements and by high- (HDT) and low-dose (LDT) ACTH stimulation tests and compared with 92 healthy controls (HC). RESULTS Baseline adrenocortical function was impaired in 39% of patients and by the end of the study, 66% of PS and 25% of KSS showed an insufficient increase after ACTH stimulation, with cortisol deficiency due to primary AI in most PS and subclinical AI in KSS. Symptomatic AI was recorded in 44% of patients. Peak cortisol levels after ACTH stimulation tests were significantly lower in patients than in HC (P < .0001), with a more reduced response to LDT vs HDT (P < .05). CONCLUSIONS Our study highlights that cortisol deficiency due to primary AI represents a relevant part of the clinical spectrum in SLSMDs, with more severe impairment in PS than in KSS. Basal and after-stimulus assessment of adrenocortical axis should be early and regularly investigated to identify any degree of adrenocortical dysfunction. The study allowed the elaboration of a diagnostic process designed for the diagnosis, treatment, and follow-up of adrenocortical abnormalities in SLSMDs.
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Affiliation(s)
- Barbara Siri
- Division of Metabolic Diseases and Hepatology, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
- Department of Paediatrics, Città della Salute e della Scienza, OIRM, University of Turin, 10126 Turin, Italy
| | - Annamaria D'Alessandro
- Clinical Biochemistry Laboratory, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Arianna Maiorana
- Division of Metabolic Diseases and Hepatology, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Ottavia Porzio
- Clinical Biochemistry Laboratory, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Lucilla Ravà
- Clinical Epidemiology Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Carlo Dionisi-Vici
- Division of Metabolic Diseases and Hepatology, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Marco Cappa
- Research Area of Innovative Therapies in Endocrinopathies, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Diego Martinelli
- Division of Metabolic Diseases and Hepatology, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
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3
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Genetic testing for mitochondrial disease: the United Kingdom best practice guidelines. Eur J Hum Genet 2023; 31:148-163. [PMID: 36513735 PMCID: PMC9905091 DOI: 10.1038/s41431-022-01249-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 11/12/2022] [Accepted: 11/16/2022] [Indexed: 12/15/2022] Open
Abstract
Primary mitochondrial disease describes a diverse group of neuro-metabolic disorders characterised by impaired oxidative phosphorylation. Diagnosis is challenging; >350 genes, both nuclear and mitochondrial DNA (mtDNA) encoded, are known to cause mitochondrial disease, leading to all possible inheritance patterns and further complicated by heteroplasmy of the multicopy mitochondrial genome. Technological advances, particularly next-generation sequencing, have driven a shift in diagnostic practice from 'biopsy first' to genome-wide analyses of blood and/or urine DNA. This has led to the need for a reference framework for laboratories involved in mitochondrial genetic testing to facilitate a consistent high-quality service. In the United Kingdom, consensus guidelines have been prepared by a working group of Clinical Scientists from the NHS Highly Specialised Service followed by national laboratory consultation. These guidelines summarise current recommended technologies and methodologies for the analysis of mtDNA and nuclear-encoded genes in patients with suspected mitochondrial disease. Genetic testing strategies for diagnosis, family testing and reproductive options including prenatal diagnosis are outlined. Importantly, recommendations for the minimum levels of mtDNA testing for the most common referral reasons are included, as well as guidance on appropriate referrals and information on the minimal appropriate gene content of panels when analysing nuclear mitochondrial genes. Finally, variant interpretation and recommendations for reporting of results are discussed, focussing particularly on the challenges of interpreting and reporting mtDNA variants.
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Abstract
Progressive external ophthalmoplegia (PEO), characterized by ptosis and impaired eye movements, is a clinical syndrome with an expanding number of etiologically distinct subtypes. Advances in molecular genetics have revealed numerous pathogenic causes of PEO, originally heralded in 1988 by the detection of single large-scale deletions of mitochondrial DNA (mtDNA) in skeletal muscle of people with PEO and Kearns-Sayre syndrome. Since then, multiple point variants of mtDNA and nuclear genes have been identified to cause mitochondrial PEO and PEO-plus syndromes, including mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) and sensory ataxic neuropathy dysarthria ophthalmoplegia (SANDO). Intriguingly, many of those nuclear DNA pathogenic variants impair maintenance of the mitochondrial genome causing downstream mtDNA multiple deletions and depletion. In addition, numerous genetic causes of nonmitochondrial PEO have been identified.
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Affiliation(s)
- Michio Hirano
- H. Houston Merritt Neuromuscular Research Center, Neuromuscular Medicine Division, Department of Neurology, Columbia University Irving Medical Center, New York, NY, United States.
| | - Robert D S Pitceathly
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, United Kingdom; NHS Highly Specialised Service for Rare Mitochondrial Disorders, Queen Square Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, London, United Kingdom
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5
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A case of chronic progressive external ophthalmoplegia presenting with central neurogenic hyperventilation. BRAIN DISORDERS 2022. [DOI: 10.1016/j.dscb.2022.100057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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6
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Masingue M, Rucheton B, Bris C, Romero NB, Procaccio V, Eymard B. Highly asymmetrical distribution of muscle wasting correlates to the heteroplasmy in a patient carrying a large-scale mitochondrial DNA deletion: a novel pathophysiological mechanism for explaining asymmetry in mitochondrial myopathies. Neuromuscul Disord 2022; 32:923-930. [PMID: 36428163 DOI: 10.1016/j.nmd.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 11/23/2022]
Abstract
Mitochondrial diseases are a heterogeneous group of pathologies, caused by missense mutations, sporadic large-scale deletions of mitochondrial DNA (mtDNA) or mutations of nuclear maintenance genes. We report the case of a patient in whom extended muscle pathology, biochemical and genetic mtDNA analyses have proven to be essential to elucidate a unique asymmetrical myopathic presentation. From the age of 34 years on, the patient has presented with oculomotor disorders, right facial peripheral palsy and predominantly left upper limb muscle weakness and atrophy. By contrast, he displayed no motor weakness on the right hemi-body, and no sensory symptoms, cerebellar syndrome, hypoacusis, or parkinsonism. Cardiac function was normal. CK levels were elevated (671 UI/L). Electroneuromyography (ENMG) and muscle MRI showed diffuse myogenic alterations, more pronounced on the left side muscles. Biopsy of the left deltoid muscle showed multiple mitochondrial defects, whereas in the right deltoid, mitochondrial defects were much less marked. Extended mitochondrial biochemical and molecular workup revealed a unique mtDNA deletion, with a 63.4% heteroplasmy load in the left deltoid, versus 8.1% in the right one. This case demonstrates that, in mitochondrial myopathies, heteroplasmy levels may drastically vary for the same type of muscle, rising the hypothesis of a new pathophysiological mechanism explaining asymmetry in hereditary myopathies.
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Affiliation(s)
- M Masingue
- Reference Center for Neuromuscular Disorders Nord/Est/Ile de France, Neuromuscular Morphology Unit, Institut de Myologie, CHU Pitié-Salpêtrière, APHP, Paris, France.
| | - B Rucheton
- UF de Biochimie des maladies neurométaboliques et neurodégénératives, Service de Biochimie Métabolique, AP-HP, Paris, France
| | - C Bris
- Department of Genetics, Angers Hospital, Angers, France; Université Angers, MitoLab Team, UMR CNRS 6015 - INSERM U1083, Institut MitoVasc, SFR ICAT, Angers, France
| | - N B Romero
- Reference Center for Neuromuscular Disorders Nord/Est/Ile de France, Neuromuscular Morphology Unit, Institut de Myologie, CHU Pitié-Salpêtrière, APHP, Paris, France; Université Sorbonne, UPMC Paris 06, INSERM UMRS974, CNRS FRE3617, Center for Research in Myology, CHU Pitié-Salpêtrière, Paris, France
| | - V Procaccio
- Department of Genetics, Angers Hospital, Angers, France; Université Angers, MitoLab Team, UMR CNRS 6015 - INSERM U1083, Institut MitoVasc, SFR ICAT, Angers, France
| | - B Eymard
- Reference Center for Neuromuscular Disorders Nord/Est/Ile de France, Neuromuscular Morphology Unit, Institut de Myologie, CHU Pitié-Salpêtrière, APHP, Paris, France.
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Long read mitochondrial genome sequencing using Cas9-guided adaptor ligation. Mitochondrion 2022; 65:176-183. [PMID: 35787470 DOI: 10.1016/j.mito.2022.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/11/2022] [Accepted: 06/19/2022] [Indexed: 11/21/2022]
Abstract
The mitochondrial genome (mtDNA) is an important source of disease-causing genetic variability, but existing sequencing methods limit understanding, precluding phased measurement of mutations and clear detection of large sporadic deletions. We adapted a method for amplification-free sequence enrichment using Cas9 cleavage to obtain full length nanopore reads of mtDNA. We then utilized the long reads to phase mutations in a patient with an mtDNA-linked syndrome and demonstrated that this method can map age-induced mtDNA deletions. We believe this method will offer deeper insight into our understanding of mtDNA variation.
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Emmanuele V, Ganesh J, Vladutiu G, Haas R, Kerr D, Saneto RP, Cohen BH, Van Hove JLK, Scaglia F, Hoppel C, Rosales XQ, Barca E, Buchsbaum R, Thompson JL, DiMauro S, Hirano M. Time to harmonize mitochondrial syndrome nomenclature and classification: A consensus from the North American Mitochondrial Disease Consortium (NAMDC). Mol Genet Metab 2022; 136:125-131. [PMID: 35606253 PMCID: PMC9341219 DOI: 10.1016/j.ymgme.2022.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 05/03/2022] [Accepted: 05/07/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To harmonize terminology in mitochondrial medicine, we propose revised clinical criteria for primary mitochondrial syndromes. METHODS The North American Mitochondrial Disease Consortium (NAMDC) established a Diagnostic Criteria Committee comprised of members with diverse expertise. It included clinicians, researchers, diagnostic laboratory directors, statisticians, and data managers. The Committee conducted a comprehensive literature review, an evaluation of current clinical practices and diagnostic modalities, surveys, and teleconferences to reach consensus on syndrome definitions for mitochondrial diseases. The criteria were refined after manual application to patients enrolled in the NAMDC Registry. RESULTS By building upon published diagnostic criteria and integrating recent advances, NAMDC has generated updated consensus criteria for the clinical definition of classical mitochondrial syndromes. CONCLUSIONS Mitochondrial diseases are clinically, biochemically, and genetically heterogeneous and therefore challenging to classify and diagnose. To harmonize terminology, we propose revised criteria for the clinical definition of mitochondrial disorders. These criteria are expected to standardize the diagnosis and categorization of mitochondrial diseases, which will facilitate future natural history studies and clinical trials.
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Affiliation(s)
- Valentina Emmanuele
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Jaya Ganesh
- Division of Genetics, Department of Pediatrics, Mount Sinai School of Medicine, New York, NY, USA
| | - Georgirene Vladutiu
- Departments of Pediatrics, Neurology, and Pathology and Anatomical Sciences, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Richard Haas
- Departments of Neurosciences and Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Douglas Kerr
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA
| | - Russell P Saneto
- Department of Neurology, Division of Pediatric Neurology, Seattle Children's Hospital/University of Washington, Seattle, WA, USA
| | - Bruce H Cohen
- Department of Pediatrics, Children's Hospital Medical Center of Akron and Northeast Ohio Medical University, Akron, OH, USA
| | - Johan L K Van Hove
- Department of Pediatrics, Section of Clinical Genetics and Metabolism, University of Colorado School of Medicine, Aurora, CO, USA
| | - Fernando Scaglia
- Department of Molecular and Human Genetics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA; Texas Children's Hospital, Houston, TX, USA; Joint BCM-CUHK Center of Medical Genetics, Prince of Wales Hospital, ShaTin, Hong Kong Special Administrative Region
| | - Charles Hoppel
- Center for Mitochondrial Disease, School of Medicine, Case Western Reserve University, Cleveland, OH, United States of America
| | - Xiomara Q Rosales
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Emanuele Barca
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Richard Buchsbaum
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - John L Thompson
- Department of Neurology, Columbia University Medical Center, New York, NY, USA; Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Salvatore DiMauro
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Michio Hirano
- Department of Neurology, Columbia University Medical Center, New York, NY, USA.
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9
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Lodato V, Parlapiano G, Calì F, Silvetti MS, Adorisio R, Armando M, El Hachem M, Romanzo A, Dionisi-Vici C, Digilio MC, Novelli A, Drago F, Raponi M, Baban A. Cardiomyopathies in Children and Systemic Disorders When Is It Useful to Look beyond the Heart? J Cardiovasc Dev Dis 2022; 9:47. [PMID: 35200700 PMCID: PMC8877723 DOI: 10.3390/jcdd9020047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 11/16/2022] Open
Abstract
Cardiomyopathy (CMP) is a rare disease in the pediatric population, with a high risk of morbidity and mortality. The genetic etiology of CMPs in children is extremely heterogenous. These two factors play a major role in the difficulties of establishing standard diagnostic and therapeutic protocols. Isolated CMP in children is a frequent finding, mainly caused by sarcomeric gene variants with a detection rate that can reach up to 50% of analyzed cohorts. Complex multisystemic forms of pediatric CMP are even more heterogenous. Few studies in literature take into consideration this topic as the main core since it represents a rarity (systemic CMP) within a rarity (pediatric population CMP). Identifying etiology in this cohort is essential for understanding prognosis, risk stratification, eligibility to heart transplantation and/or mechanical-assisted procedures, preventing multiorgan complications, and relatives' recurrence risk calculation. The previous points represent a cornerstone in patients' empowerment and personalized medical care approach. The aim of this work is to propose a new approach for an algorithm in the setting of the diagnostic framework of systemic pediatric CMP. On the other hand, during the literature review, we noticed a relatively common etiologic pattern in some forms of complex/multisystem CMP. In other words, certain syndromes such as Danon, Vici, Alström, Barth, and Myhre syndrome share a common pathway of directly or indirectly defective "autophagy" process, which appears to be a possible initiating/triggering factor for CMPs. This conjoint aspect could be important for possible prognostic/therapeutic implications in this category of patients. However, multicentric studies detailed functional and experimental models are needed prior to deriving conclusions.
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Affiliation(s)
- Valentina Lodato
- The European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Pediatric Cardiology and Arrhythmia/Syncope Units, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy; (V.L.); (G.P.); (F.C.); (M.S.S.); (F.D.)
| | - Giovanni Parlapiano
- The European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Pediatric Cardiology and Arrhythmia/Syncope Units, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy; (V.L.); (G.P.); (F.C.); (M.S.S.); (F.D.)
- Laboratory of Medical Genetics, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy;
| | - Federica Calì
- The European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Pediatric Cardiology and Arrhythmia/Syncope Units, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy; (V.L.); (G.P.); (F.C.); (M.S.S.); (F.D.)
| | - Massimo Stefano Silvetti
- The European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Pediatric Cardiology and Arrhythmia/Syncope Units, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy; (V.L.); (G.P.); (F.C.); (M.S.S.); (F.D.)
| | - Rachele Adorisio
- Heart Failure Clinic-Heart Failure, Heart Transplant, Mechanical Circulatory Support Unit, Department of Pediatric Cardiology and Cardiac Surgery, Heart and Lung Transplant, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy;
| | - Michela Armando
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy;
| | - May El Hachem
- Dermatology and Genodermatosis Units, Genetics and Rare Disease Research Division, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy;
| | - Antonino Romanzo
- Ophtalmology Unit, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy;
| | - Carlo Dionisi-Vici
- Division of Metabolism, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy;
| | - Maria Cristina Digilio
- Genetics and Rare Diseases Research Division, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy;
| | - Antonio Novelli
- Laboratory of Medical Genetics, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy;
| | - Fabrizio Drago
- The European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Pediatric Cardiology and Arrhythmia/Syncope Units, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy; (V.L.); (G.P.); (F.C.); (M.S.S.); (F.D.)
| | - Massimiliano Raponi
- Medical Direction, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy;
| | - Anwar Baban
- The European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Pediatric Cardiology and Arrhythmia/Syncope Units, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy; (V.L.); (G.P.); (F.C.); (M.S.S.); (F.D.)
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10
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Baban A, Lodato V, Parlapiano G, di Mambro C, Adorisio R, Bertini ES, Dionisi-Vici C, Drago F, Martinelli D. Myocardial and Arrhythmic Spectrum of Neuromuscular Disorders in Children. Biomolecules 2021; 11:1578. [PMID: 34827576 PMCID: PMC8615674 DOI: 10.3390/biom11111578] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/02/2021] [Accepted: 10/14/2021] [Indexed: 12/30/2022] Open
Abstract
Neuromuscular disorders (NMDs) are highly heterogenous from both an etiological and clinical point of view. Their signs and symptoms are often multisystemic, with frequent cardiac involvement. In fact, childhood onset forms can predispose a person to various progressive cardiac abnormalities including cardiomyopathies (CMPs), valvulopathies, atrioventricular conduction defects (AVCD), supraventricular tachycardia (SVT) and ventricular arrhythmias (VA). In this review, we selected and described five specific NMDs: Friedreich's Ataxia (FRDA), congenital and childhood forms of Myotonic Dystrophy type 1 (DM1), Kearns Sayre Syndrome (KSS), Ryanodine receptor type 1-related myopathies (RYR1-RM) and Laminopathies. These changes are widely investigated in adults but less researched in children. We focused on these specific topics due their relative frequency and their potential unexpected cardiac manifestations in children. Moreover these conditions present different inheritance patterns and mechanisms of action. We decided not to discuss Duchenne and Becker muscular dystrophies due to extensive work regarding the cardiac aspects in children. For each described NMD, we focused on the possible cardiac manifestations such as different types of CMPs (dilated-DCM, hypertrophic-HCM, restrictive-RCM or left ventricular non compaction-LVNC), structural heart abnormalities (including valvulopathies), and progressive heart rhythm changes (AVCD, SVT, VA). We describe the current management strategies for these conditions. We underline the importance, especially for children, of a serial multidisciplinary personalized approach and the need for periodic surveillance by a dedicated heart team. This is largely due to the fact that in children, the diagnosis of certain NMDs might be overlooked and the cardiac aspect can provide signs of their presence even prior to overt neurological diagnosis.
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Affiliation(s)
- Anwar Baban
- The European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Department of Pediatric Cardiology and Cardiac Surgery, Heart and Lung Transplantation, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy; (V.L.); (C.d.M.); (R.A.); (F.D.)
| | - Valentina Lodato
- The European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Department of Pediatric Cardiology and Cardiac Surgery, Heart and Lung Transplantation, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy; (V.L.); (C.d.M.); (R.A.); (F.D.)
| | - Giovanni Parlapiano
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unit, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy;
| | - Corrado di Mambro
- The European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Department of Pediatric Cardiology and Cardiac Surgery, Heart and Lung Transplantation, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy; (V.L.); (C.d.M.); (R.A.); (F.D.)
| | - Rachele Adorisio
- The European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Department of Pediatric Cardiology and Cardiac Surgery, Heart and Lung Transplantation, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy; (V.L.); (C.d.M.); (R.A.); (F.D.)
| | - Enrico Silvio Bertini
- The European Reference Network for Neuromuscular Disorders (ERN NMD), Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00146 Rome, Italy;
| | - Carlo Dionisi-Vici
- Division of Metabolism, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy; (C.D.-V.); (D.M.)
| | - Fabrizio Drago
- The European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Department of Pediatric Cardiology and Cardiac Surgery, Heart and Lung Transplantation, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy; (V.L.); (C.d.M.); (R.A.); (F.D.)
| | - Diego Martinelli
- Division of Metabolism, Bambino Gesù Children Hospital and Research Institute, IRCCS, 00165 Rome, Italy; (C.D.-V.); (D.M.)
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11
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Kierdaszuk B, Kaliszewska M, Rusecka J, Kosińska J, Bartnik E, Tońska K, Kamińska AM, Kostera-Pruszczyk A. Progressive External Ophthalmoplegia in Polish Patients-From Clinical Evaluation to Genetic Confirmation. Genes (Basel) 2020; 12:genes12010054. [PMID: 33396418 PMCID: PMC7824435 DOI: 10.3390/genes12010054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 12/27/2020] [Accepted: 12/28/2020] [Indexed: 11/16/2022] Open
Abstract
Mitochondrial encephalomyopathies comprise a group of heterogeneous disorders resulting from impaired oxidative phosphorylation (OxPhos). Among a variety of symptoms progressive external ophthalmoplegia (PEO) seems to be the most common. The aim of this study is to present clinical and genetic characteristics of Polish patients with PEO. Clinical, electrophysiological, neuroradiological, and morphological data of 84 patients were analyzed. Genetic studies of mitochondrial DNA (mtDNA) were performed in all patients. Among nuclear DNA (nDNA) genes POLG was sequenced in 41 patients, TWNK (C10orf2) in 13 patients, and RNASEH1 in 2 patients. Total of 27 patients were included in the chronic progressive external ophthalmoplegia (CPEO) group, 24 in the CPEO+ group. Twenty-six patients had mitochondrial encephalomyopathy (ME), six patients Kearns-Sayre syndrome (KSS), and one patient sensory ataxic neuropathy, dysarthria, ophthalmoparesis (SANDO) syndrome. Genetic analysis of nDNA genes revealed the presence of pathogenic or possibly pathogenic variants in the POLG gene in nine patients, the TWNK gene in five patients and the RNASEH1 gene in two patients. Detailed patients' history and careful assessment of family history are essential in the diagnostic work-up. Genetic studies of both mtDNA and nDNA are necessary for the final diagnosis of progressive external ophthalmoplegia and for genetic counseling.
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MESH Headings
- Adolescent
- Adult
- Aged
- Cerebellum/diagnostic imaging
- Cerebellum/metabolism
- Cerebellum/pathology
- Cerebrum/diagnostic imaging
- Cerebrum/metabolism
- Cerebrum/pathology
- Child
- DNA Helicases/genetics
- DNA Helicases/metabolism
- DNA Polymerase gamma/genetics
- DNA Polymerase gamma/metabolism
- DNA, Mitochondrial/genetics
- DNA, Mitochondrial/metabolism
- Diagnosis, Differential
- Female
- Gene Expression
- Humans
- Kearns-Sayre Syndrome/diagnostic imaging
- Kearns-Sayre Syndrome/genetics
- Kearns-Sayre Syndrome/metabolism
- Kearns-Sayre Syndrome/pathology
- Male
- Middle Aged
- Mitochondria/metabolism
- Mitochondria/pathology
- Mitochondrial Diseases/diagnostic imaging
- Mitochondrial Diseases/genetics
- Mitochondrial Diseases/metabolism
- Mitochondrial Diseases/pathology
- Mitochondrial Encephalomyopathies/diagnostic imaging
- Mitochondrial Encephalomyopathies/genetics
- Mitochondrial Encephalomyopathies/metabolism
- Mitochondrial Encephalomyopathies/pathology
- Mitochondrial Proteins/genetics
- Mitochondrial Proteins/metabolism
- Muscle, Skeletal/metabolism
- Muscle, Skeletal/pathology
- Ophthalmoplegia, Chronic Progressive External/diagnostic imaging
- Ophthalmoplegia, Chronic Progressive External/genetics
- Ophthalmoplegia, Chronic Progressive External/metabolism
- Ophthalmoplegia, Chronic Progressive External/pathology
- Pedigree
- Poland
- Polymorphism, Genetic
- Ribonuclease H/genetics
- Ribonuclease H/metabolism
- Sequence Deletion
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Affiliation(s)
- Biruta Kierdaszuk
- Department of Neurology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland; (A.M.K.); (A.K.-P.)
- Correspondence: ; Tel.: +48-22-599-2858; Fax: +48-22-599-1857
| | - Magdalena Kaliszewska
- Institute of Genetics and Biotechnology, Faculty of Biology, University of Warsaw, Pawinskiego 5a, 02-106 Warsaw, Poland; (M.K.); (J.R.); (E.B.); (K.T.)
| | - Joanna Rusecka
- Institute of Genetics and Biotechnology, Faculty of Biology, University of Warsaw, Pawinskiego 5a, 02-106 Warsaw, Poland; (M.K.); (J.R.); (E.B.); (K.T.)
| | - Joanna Kosińska
- Department of Medical Genetics, Medical University of Warsaw, Pawinskiego 3c, 02-106 Warsaw, Poland;
| | - Ewa Bartnik
- Institute of Genetics and Biotechnology, Faculty of Biology, University of Warsaw, Pawinskiego 5a, 02-106 Warsaw, Poland; (M.K.); (J.R.); (E.B.); (K.T.)
| | - Katarzyna Tońska
- Institute of Genetics and Biotechnology, Faculty of Biology, University of Warsaw, Pawinskiego 5a, 02-106 Warsaw, Poland; (M.K.); (J.R.); (E.B.); (K.T.)
| | - Anna M. Kamińska
- Department of Neurology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland; (A.M.K.); (A.K.-P.)
| | - Anna Kostera-Pruszczyk
- Department of Neurology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland; (A.M.K.); (A.K.-P.)
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12
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Varhaug KN, Nido GS, de Coo I, Isohanni P, Suomalainen A, Tzoulis C, Knappskog P, Bindoff LA. Using urine to diagnose large-scale mtDNA deletions in adult patients. Ann Clin Transl Neurol 2020; 7:1318-1326. [PMID: 32634300 PMCID: PMC7448145 DOI: 10.1002/acn3.51119] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate if urinary sediment cells offered a robust alternative to muscle biopsy for the diagnosis of single mtDNA deletions. METHODS Eleven adult patients with progressive external ophthalmoplegia and a known single mtDNA deletion were investigated. Urinary sediment cells were used to isolate DNA, which was then subjected to long-range polymerase chain reaction. Where available, the patient`s muscle DNA was studied in parallel. Breakpoint and thus deletion size were identified using both Sanger sequencing and next generation sequencing. The level of heteroplasmy was determined using quantitative polymerase chain reaction. RESULTS We identified the deletion in urine in 9 of 11 cases giving a sensitivity of 80%. Breakpoints and deletion size were readily detectable in DNA extracted from urine. Mean heteroplasmy level in urine was 38% ± 26 (range 8 - 84%), and 57% ± 28 (range 12 - 94%) in muscle. While the heteroplasmy level in urinary sediment cells differed from that in muscle, we did find a statistically significant correlation between these two levels (R = 0.714, P = 0.031(Pearson correlation)). INTERPRETATION Our findings suggest that urine can be used to screen patients suspected clinically of having a single mtDNA deletion. Based on our data, the use of urine could considerably reduce the need for muscle biopsy in this patient group.
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Affiliation(s)
- Kristin N Varhaug
- Department of Neurology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway
| | - Gonzalo S Nido
- Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway.,Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Irenaeus de Coo
- Department of Neurology, Medical Spectrum Twente, Enschede, The Netherlands.,Department of Genetics and Cell Biology, University of Maastricht, Maastricht, The Netherlands
| | - Pirjo Isohanni
- Research Programs Unit, Stem Cells and Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Children´s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anu Suomalainen
- Research Programs Unit, Stem Cells and Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,HUSlab, Helsinki University Hospital Helsinki, Helsinki, Finland.,Neuroscience Center, University of Helsinki, Hilife, Helsinki, Finland
| | - Charalampos Tzoulis
- Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway.,Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Per Knappskog
- Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Laurence A Bindoff
- Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway.,Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway
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13
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Lu JQ, Tarnopolsky MA. Response to "Relation between intra-mitochondrial inclusions and pathophysiology of mitochondrial myopathy remains unprecise". J Neurol Sci 2020; 414:116895. [PMID: 32418625 DOI: 10.1016/j.jns.2020.116895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 05/07/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Jian-Qiang Lu
- Department of Pathology and Molecular Medicine/Neuropathology, Hamilton, Ontario, Canada.
| | - Mark A Tarnopolsky
- Department of Medicine/Neurology, Hamilton, Ontario, Canada; Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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14
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Papadopoulos C, Wahbi K, Behin A, Bougouin W, Stojkovic T, Leonard-Louis S, Berber N, Lombès A, Duboc D, Jardel C, Eymard B, Laforêt P. Incidence and predictors of total mortality in 267 adults presenting with mitochondrial diseases. J Inherit Metab Dis 2020; 43:459-466. [PMID: 31652339 DOI: 10.1002/jimd.12185] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 10/20/2019] [Accepted: 10/23/2019] [Indexed: 11/10/2022]
Abstract
Assessing long-term mortality and identifying predictors of death in adults with mitochondrial diseases. We retrospectively included adult patients with genetically proven mitochondrial diseases referred to our centre between January 2000 and June 2016, and collected information relative to their genetic testing, clinical assessments, and vital status. We performed single and multiple variable analyses in search of predictors of total mortality, and calculated hazard ratios (HR) and 95% confidence intervals (CI). We included 267 patients (women 59%; median age 43.3 [31.3-54.2] years), including 111 with mitochondrial DNA (mtDNA) single large-scale deletions, 65 with m.3243A>G, 24 with m.8344A>G, 32 with other mtDNA point mutations, and 36 patients with nuclear genes mutations. Over a median follow-up of 8.9 years (0.3 to 18.7), 61 patients (22.8%) died, at a median age of 50.7 (37.9-51.9) years. Primary cause of death was cardiovascular disease in 16 patients (26.2%), respiratory in 11 (18.0%), and gastrointestinal in 5 (8.1%). By multiple variable analysis, diabetes (HR 2.75; 95% CI 1.46-5.18), intraventricular cardiac conduction defects (HR 3.38; 95% CI 1.71-6.76) and focal brain involvement (HR 2.39; 95% CI 1.25-4.57) were independent predictors of death. Adult patients with mitochondrial diseases present high morbidity that can be independently predicted by the presence of diabetes, intraventricular cardiac conduction defects, and focal brain involvement.
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Affiliation(s)
- Constantinos Papadopoulos
- APHP, Pitié-Salpêtrère Hospital, Nord/Est/Ile de France Neuromuscular Reference Center, Myology Institute, Paris, France
- First Department of Neurology, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Karim Wahbi
- APHP, Cochin Hospital, Cardiology Department, FILNEMUS, Paris-Descartes, Sorbonne Paris Cité University, Paris, France
- INSERM Unit 970, Paris Cardiovascular Research Centre (PARCC), Paris, France
| | - Anthony Behin
- APHP, Pitié-Salpêtrère Hospital, Nord/Est/Ile de France Neuromuscular Reference Center, Myology Institute, Paris, France
| | - Wulfran Bougouin
- INSERM Unit 970, Paris Cardiovascular Research Centre (PARCC), Paris, France
- Medical Intensive Care Unit, AP-HP, Cochin Hospital, Paris, France
| | - Tanya Stojkovic
- APHP, Pitié-Salpêtrère Hospital, Nord/Est/Ile de France Neuromuscular Reference Center, Myology Institute, Paris, France
| | - Sarah Leonard-Louis
- APHP, Pitié-Salpêtrère Hospital, Nord/Est/Ile de France Neuromuscular Reference Center, Myology Institute, Paris, France
| | - Nawal Berber
- APHP, Pitié-Salpêtrère Hospital, Nord/Est/Ile de France Neuromuscular Reference Center, Myology Institute, Paris, France
| | - Anne Lombès
- INSERM, UMRS 975, APHP, Cochin Hospital, Paris, France
| | - Denis Duboc
- APHP, Cochin Hospital, Cardiology Department, FILNEMUS, Paris-Descartes, Sorbonne Paris Cité University, Paris, France
| | - Claude Jardel
- Biochemistry Department and Genetic Center, APHP, Pitié-Salpêtrière Hospital, Paris, France
- Inserm U 1016, CNRS UMR 8104, Institut Cochin, Paris, France
- GRC-UPMC Neuro-métabolisme, Université Pierre et Marie Curie, Paris, France
| | - Bruno Eymard
- APHP, Pitié-Salpêtrère Hospital, Nord/Est/Ile de France Neuromuscular Reference Center, Myology Institute, Paris, France
| | - Pascal Laforêt
- APHP, Raymond-Poincaré Teaching Hospital, Neurology department, Nord/Est/Ile de France Neuromuscular Reference Center, Garches, France
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15
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Zhunina OA, Yabbarov NG, Grechko AV, Yet SF, Sobenin IA, Orekhov AN. Neurodegenerative Diseases Associated with Mitochondrial DNA Mutations. Curr Pharm Des 2020; 26:103-109. [DOI: 10.2174/1381612825666191122091320] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 11/19/2019] [Indexed: 01/23/2023]
Abstract
Mitochondrial dysfunction underlies several human chronic pathologies, including cardiovascular
disorders, cancers and neurodegenerative diseases. Impaired mitochondrial function associated with oxidative
stress can be a result of both nuclear and mitochondrial DNA (mtDNA) mutations. Neurological disorders associated
with mtDNA mutations include mitochondrial encephalomyopathy, chronic progressive external ophthalmoplegia,
neurogenic weakness, and Leigh syndrome. Moreover, mtDNA mutations were shown to play a role in the
development of Parkinson and Alzheimer’s diseases. In this review, current knowledge on the distribution and
possible roles of mtDNA mutations in the onset and development of various neurodegenerative diseases, with
special focus on Parkinson’s and Alzheimer’s diseases has been discussed.
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Affiliation(s)
- Olga A. Zhunina
- Russian Research Center for Molecular Diagnostics and Therapy, Simferopolsky Blvd., 8, 117149, Moscow, Russian Federation
| | - Nikita G. Yabbarov
- Russian Research Center for Molecular Diagnostics and Therapy, Simferopolsky Blvd., 8, 117149, Moscow, Russian Federation
| | - Andrey V. Grechko
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 14-3 Solyanka Street, 109240, Moscow, Russian Federation
| | - Shaw-Fang Yet
- Institute of Cellular and System Medicine, National Health Research Institutes, 35 Keyan Road, Zhunan Town, Miaoli County 35053, Taiwan
| | - Igor A. Sobenin
- Laboratory of Medical Genetics, National Medical Research Center of Cardiology, 15A 3rd Cherepkovskaya Street, Moscow 121552, Russian Federation
| | - Alexander N. Orekhov
- Institute of Human Morphology, 3 Tsyurupa Street, Moscow 117418, Russian Federation
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16
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Mitochondrial disorders and the eye. Surv Ophthalmol 2019; 65:294-311. [PMID: 31783046 DOI: 10.1016/j.survophthal.2019.11.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 11/16/2019] [Accepted: 11/18/2019] [Indexed: 01/27/2023]
Abstract
Mitochondria are cellular organelles that play a key role in energy metabolism and oxidative phosphorylation. Malfunctioning of mitochondria has been implicated as the cause of many disorders with variable inheritance, heterogeneity of systems involved, and varied phenotype. Metabolically active tissues are more likely to be affected, causing an anatomic and physiologic disconnect in the treating physicians' mind between presentation and underlying pathophysiology. We shall focus on disorders of mitochondrial metabolism relevant to an ophthalmologist. These disorders can affect all parts of the visual pathway (crystalline lens, extraocular muscles, retina, optic nerve, and retrochiasm). After the introduction reviewing mitochondrial structure and function, each disorder is reviewed in detail, including approaches to its diagnosis and most current management guidelines.
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17
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Cardiovascular Manifestations of Mitochondrial Disease. BIOLOGY 2019; 8:biology8020034. [PMID: 31083569 PMCID: PMC6628328 DOI: 10.3390/biology8020034] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/13/2019] [Accepted: 04/22/2019] [Indexed: 02/06/2023]
Abstract
Genetic mitochondrial cardiomyopathies are uncommon causes of heart failure that may not be seen by most physicians. However, the prevalence of mitochondrial DNA mutations and somatic mutations affecting mitochondrial function are more common than previously thought. In this review, the pathogenesis of genetic mitochondrial disorders causing cardiovascular disease is reviewed. Treatment options are presently limited to mostly symptomatic support, but preclinical research is starting to reveal novel approaches that may lead to better and more targeted therapies in the future. With better understanding and clinician education, we hope to improve clinician recognition and diagnosis of these rare disorders in order to improve ongoing care of patients with these diseases and advance research towards discovering new therapeutic strategies to help treat these diseases.
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18
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Kozak I, Oystreck DT, Abu-Amero KK, Nowilaty SR, Alkhalidi H, Elkhamary SM, Mohamed S, Hamad MHA, Salih MA, Blakely EL, Taylor RW, Bosley TM. NEW OBSERVATIONS REGARDING THE RETINOPATHY OF GENETICALLY CONFIRMED KEARNS-SAYRE SYNDROME. Retin Cases Brief Rep 2018; 12:349-358. [PMID: 28296806 DOI: 10.1097/icb.0000000000000503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE To report novel retinal findings in Kearns-Sayre syndrome and correlate degree of retinopathy with other clinical findings. METHODS Observational case series of patients from Saudi Arabia with retinal and neuroophthalmologic examinations, medical chart review, and mitochondrial genetic evaluation. RESULTS The three unrelated patients had progressive external ophthalmoplegia and pigmentary retinopathy bilaterally. Muscle biopsy in two of the cases revealed mitochondrial myopathy. All three had abnormal findings on neuroimaging and modestly reduced visual acuity in both eyes with a variable pigmentary retinopathy. One of the patients had bilateral subretinal fibrosis with a full-thickness macular hole in the right eye. All three patients had single, large-scale mitochondrial DNA (mtDNA) deletions (5.0-7.6 kb in size) with blood mtDNA heteroplasmy levels ranging from below 20% to 57%. Severity of pigmentary retinopathy did not correlate with severity of progressive external ophthalmoplegia, but did correspond grossly with electroretinographic abnormalities, just as the degree of ocular motility restriction and ptosis in each patient correlated with the size of their extraocular muscles on neuroimaging. In addition, the size of the single, large-scale mtDNA deletion and level of mtDNA heteroplasmy corresponded with degree of ocular motility restriction but not with severity of retinopathy. CONCLUSION Subretinal fibrosis and macular hole are novel retinal observations which expand clinical profile in Kearns-Sayre syndrome. Genetic testing for mtDNA deletions and heteroplasmy in blood, muscle biopsy, careful ocular and retinal examination including electroretinography, and imaging are indispensable tests for this condition.
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Affiliation(s)
- Igor Kozak
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Darren T Oystreck
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- The Division of Ophthalmology, Faculty of Health Sciences, University of Stellenbosch, Tygerberg, South Africa
| | - Khaled K Abu-Amero
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Ophthalmology, College of Medicine, University of Florida, Jacksonville, Florida
| | | | | | | | - Sarar Mohamed
- Pediatrics, College of Medicine, King Saud University Riyadh, Saudi Arabia
| | | | - Mustafa A Salih
- Pediatrics, College of Medicine, King Saud University Riyadh, Saudi Arabia
| | - Emma L Blakely
- The Wellcome Trust Centre for Mitochondrial Research, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Robert W Taylor
- The Wellcome Trust Centre for Mitochondrial Research, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Thomas M Bosley
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- The Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
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19
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Hedermann G, Dahlqvist JR, Løkken N, Vissing CR, Knak KL, Andersen LK, Thomsen C, Vissing J. Progressive fat replacement of muscle contributes to the disease mechanism of patients with single, large-scale deletions of mitochondrial DNA. Neuromuscul Disord 2018; 28:408-413. [DOI: 10.1016/j.nmd.2018.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 12/23/2017] [Accepted: 02/13/2018] [Indexed: 10/18/2022]
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20
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Finsterer J, Rauschka H, Segal L, Kovacs GG, Rolinski B. Affection of the Respiratory Muscles in Combined Complex I and IV Deficiency. Open Neurol J 2017; 11:1-6. [PMID: 28217183 PMCID: PMC5301300 DOI: 10.2174/1874205x01711010001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 12/08/2016] [Accepted: 12/13/2016] [Indexed: 11/22/2022] Open
Abstract
Objectives: Combined complex I+IV deficiency has rarely been reported to manifest with the involvement of the respiratory muscles. Case Report: A 45y male was admitted for hypercapnia due to muscular respiratory insufficiency. He required intubation and mechanical ventilation. He had a previous history of ophthalmoparesis since age 6y, ptosis since age 23y, and anterocollis since at least age 40y. Muscle biopsy from the right deltoid muscle at age 41y was indicative of mitochondrial myopathy. Biochemical investigations revealed a combined complex I+IV defect. Respiratory insufficiency was attributed to mitochondrial myopathy affecting not only the extra-ocular and the axial muscles but also the shoulder girdle and respiratory muscles. In addition to myopathy, he had mitochondrial neuropathy, abnormal EEG, and elevated CSF-protein. Possibly, this is why a single cycle of immunoglobulins was somehow beneficial. For muscular respiratory insufficiency he required tracheostomy and was scheduled for long-term intermittent positive pressure ventilation. Conclusion: Mitochondrial myopathy due to a combined complex I+IV defect with predominant affection of the extra-ocular muscles may progress to involvement of the limb-girdle, axial and respiratory muscles resulting in muscular respiratory insufficiency. In patients with mitochondrial myopathy, neuropathy and elevated cerebrospinal fluid protein, immunoglobulins may be beneficial even for respiratory functions.
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Affiliation(s)
| | | | - Liane Segal
- Department of Anesthesiology, Krankenanstalt Rudolfstiftung, Vienna, Austria
| | - Gabor G Kovacs
- Institute of Clinical Neurology, AKH Wien, Vienna, Austria
| | - Boris Rolinski
- Institute of Clinical Chemistry, Academic Hospital München-Schwabing, Germany
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21
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Hedermann G, Løkken N, Dahlqvist JR, Vissing J. Dysphagia is prevalent in patients with CPEO and single, large-scale deletions in mtDNA. Mitochondrion 2017; 32:27-30. [DOI: 10.1016/j.mito.2016.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/08/2016] [Accepted: 11/11/2016] [Indexed: 10/20/2022]
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22
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Brunel-Guitton C, Levtova A, Sasarman F. Mitochondrial Diseases and Cardiomyopathies. Can J Cardiol 2015; 31:1360-76. [DOI: 10.1016/j.cjca.2015.08.017] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 08/21/2015] [Accepted: 08/21/2015] [Indexed: 12/31/2022] Open
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23
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Lombès A, Auré K, Jardel C. [Pathophysiology of human mitochondrial diseases]. Biol Aujourdhui 2015; 209:125-132. [PMID: 26514381 DOI: 10.1051/jbio/2015014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Indexed: 06/05/2023]
Abstract
Mitochondrial diseases, defined as the diseases due to oxidative phosphorylation defects, are the most frequent inborn errors of metabolism. Their clinical presentation is highly diverse. Their diagnosis is difficult. It relies on metabolic parameters, histological anomalies and enzymatic assays showing defective activity, all of which are both inconstant and relatively unspecific. Most mitochondrial diseases have a genetic origin. Candidate genes are very numerous, located either in the mitochondrial genome or the nuclear DNA. Pathophysiological mechanisms of mitochondrial diseases are still the matter of much debate. Those underlying the tissue-specificity of diseases due to the alterations of a ubiquitously expressed gene are discussed including (i) quantitative aspect of the expression of the causal gene or its partners when appropriate, (ii) quantitative aspects of the bioenergetic function in each tissue, and (iii) tissue distribution of heteroplasmic mitochondrial DNA alterations.
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Affiliation(s)
- Anne Lombès
- Inserm U1016,CNRS UMR 8104, Institut Cochin, 24 rue du Faubourg Saint Jacques, 75014 Paris, France - Université Paris-Descartes-Paris 5, 75014 Paris, France
| | - Karine Auré
- Inserm U1016,CNRS UMR 8104, Institut Cochin, 24 rue du Faubourg Saint Jacques, 75014 Paris, France - AP-HP, Hôpital Ambroise Paré, Service d'Explorations Fonctionnelles, 92100 Boulogne-Billancourt, France - Université Versailles-Saint-Quentin en Yvelines, 78180 Montigny-Le-Bretonneux, France
| | - Claude Jardel
- Inserm U1016,CNRS UMR 8104, Institut Cochin, 24 rue du Faubourg Saint Jacques, 75014 Paris, France - AP-HP, Service de Biochimie Métabolique et Centre de Génétique moléculaire et chromosomique, CHU Pitié-Salpêtrière, 75651 Paris, France
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24
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Wahbi K, Bougouin W, Béhin A, Stojkovic T, Bécane HM, Jardel C, Berber N, Mochel F, Lombès A, Eymard B, Duboc D, Laforêt P. Long-term cardiac prognosis and risk stratification in 260 adults presenting with mitochondrial diseases. Eur Heart J 2015. [DOI: 10.1093/eurheartj/ehv307] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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25
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Tchikviladzé M, Gilleron M, Maisonobe T, Galanaud D, Laforêt P, Durr A, Eymard B, Mochel F, Ogier H, Béhin A, Stojkovic T, Degos B, Gourfinkel-An I, Sedel F, Anheim M, Elbaz A, Viala K, Vidailhet M, Brice A, Jardel C, Lombès A. A diagnostic flow chart for POLG-related diseases based on signs sensitivity and specificity. J Neurol Neurosurg Psychiatry 2015; 86:646-54. [PMID: 25118206 DOI: 10.1136/jnnp-2013-306799] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 07/23/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Diseases due to mutations of POLG gene, encoding the mitochondrial DNA polymerase, are reputed to have very diverse clinical presentations and have been proposed to cause up to 25% adult mitochondrial diseases. Our objective was the evaluation of the specificity and sensitivity of the signs encountered with POLG mutations. DESIGN Forty-four patients out of 154 with sequenced POLG gene had mutations affecting either one (POLG(+/-) group) or two POLG alleles (POLG(+/+) group). Phenotyping included clinical signs, electroneuromyography and brain imaging while mitochondrial investigations encompassed muscle histochemistry, respiratory chain assays and search for multiple mitochondrial deletions. The specificity and sensitivity of the signs associated with POLG mutations were analysed by comparison between POLG(+/+) and patients without POLG mutation. RESULTS High sensitivity but low specificity was observed with single signs such as axonal sensory neuropathy, cerebellar syndrome, movement disorders and weakness involving ocular, pharyngeal, axial and/or limb muscles. Specificity was increased with combination of previous signs plus psychiatric symptoms, cognitive impairment and epilepsy. High specificity and sensitivity was only obtained with sensory neuronopathy associated with one of the following signs: weakness of ocular, pharyngeal, axial and/or limb muscles. Mitochondrial investigations did not suffice for diagnosis. The widespread neuromuscular signs were often present since disease onset and were the rule above 50 years of age leading to a very low probability of POLG mutations in patients with less than three signs and absent sensory neuropathy. CONCLUSIONS Phenotypes associated with POLG mutations follow a reproducible pattern, which allows establishing a diagnostic flow chart.
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Affiliation(s)
- Maya Tchikviladzé
- Department of Neurology, AP-HP, GHU Pitié-Salpêtrière, Paris, France INSERM CIC9503, GHU Pitié-Salpêtrière, Paris, France
| | - Mylène Gilleron
- INSERM U1016, Institut Cochin; CNRS UMR 8104, Paris, France Service de Biochimie Métabolique et Centre de Génétique moléculaire et chromosomique, AP-HP, GHU Pitié-Salpêtrière, Paris, France UPMC Univ Paris 06, UMR_S975, Paris, France
| | - Thierry Maisonobe
- Department of Neurophysiology and Neuropathology, AP-HP, GHU Pitié-Salpêtrière, Paris, France
| | - Damien Galanaud
- Department of Neuroradiology, AP-HP, GHU Pitié-Salpêtrière, Paris, France
| | - Pascal Laforêt
- AP-HP, Centre de Référence de pathologie neuromusculaire Paris-Est, Institut de Myologie, GHU Pitié-Salpêtrière, Paris, France
| | - Alexandra Durr
- UPMC Univ Paris 06, UMR_S975, Paris, France Department of Genetics, AP-HP, GHU Pitié-Salpêtrière, Paris, France INSERM UMR_S975, CRICM; CNRS UMR 7225, Paris, France ICM (Brain and Spine Institute) GH Pitié-Salpêtrière, Paris, France
| | - Bruno Eymard
- UPMC Univ Paris 06, UMR_S975, Paris, France AP-HP, Centre de Référence de pathologie neuromusculaire Paris-Est, Institut de Myologie, GHU Pitié-Salpêtrière, Paris, France INSERM UMR_S975, CRICM; CNRS UMR 7225, Paris, France
| | - Fanny Mochel
- Department of Genetics, AP-HP, GHU Pitié-Salpêtrière, Paris, France INSERM UMR_S975, CRICM; CNRS UMR 7225, Paris, France Neurometabolic Unit, AP-HP, GH Pitié-Salpêtrière, Paris, France
| | - Hélène Ogier
- AP-HP, Maladies héréditaires du métabolisme, GH Robert Debré, Paris, France
| | - Anthony Béhin
- AP-HP, Centre de Référence de pathologie neuromusculaire Paris-Est, Institut de Myologie, GHU Pitié-Salpêtrière, Paris, France
| | - Tanya Stojkovic
- AP-HP, Centre de Référence de pathologie neuromusculaire Paris-Est, Institut de Myologie, GHU Pitié-Salpêtrière, Paris, France
| | - Bertrand Degos
- Department of Neurology, AP-HP, GHU Pitié-Salpêtrière, Paris, France
| | | | - Frederic Sedel
- Department of Genetics, AP-HP, GHU Pitié-Salpêtrière, Paris, France INSERM UMR_S975, CRICM; CNRS UMR 7225, Paris, France Neurometabolic Unit, AP-HP, GH Pitié-Salpêtrière, Paris, France
| | - Mathieu Anheim
- Department of Neurology, AP-HP, GHU Pitié-Salpêtrière, Paris, France
| | - Alexis Elbaz
- INSERM, CESP, Social and occupational determinants of health, U1018, Villejuif, France Université Versailles St-Quentin, UMRS 1018, Villejuif, France
| | - Karine Viala
- Department of Neurophysiology and Neuropathology, AP-HP, GHU Pitié-Salpêtrière, Paris, France
| | - Marie Vidailhet
- Department of Neurology, AP-HP, GHU Pitié-Salpêtrière, Paris, France INSERM UMR_S975, CRICM; CNRS UMR 7225, Paris, France ICM (Brain and Spine Institute) GH Pitié-Salpêtrière, Paris, France Neurometabolic Unit, AP-HP, GH Pitié-Salpêtrière, Paris, France
| | - Alexis Brice
- UPMC Univ Paris 06, UMR_S975, Paris, France Department of Genetics, AP-HP, GHU Pitié-Salpêtrière, Paris, France INSERM UMR_S975, CRICM; CNRS UMR 7225, Paris, France ICM (Brain and Spine Institute) GH Pitié-Salpêtrière, Paris, France
| | - Claude Jardel
- INSERM U1016, Institut Cochin; CNRS UMR 8104, Paris, France Service de Biochimie Métabolique et Centre de Génétique moléculaire et chromosomique, AP-HP, GHU Pitié-Salpêtrière, Paris, France
| | - Anne Lombès
- INSERM U1016, Institut Cochin; CNRS UMR 8104, Paris, France Service de Biochimie Métabolique et Centre de Génétique moléculaire et chromosomique, AP-HP, GHU Pitié-Salpêtrière, Paris, France Université Paris-Descartes-Paris5, Paris, France
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Broomfield A, Sweeney MG, Woodward CE, Fratter C, Morris AM, Leonard JV, Abulhoul L, Grunewald S, Clayton PT, Hanna MG, Poulton J, Rahman S. Paediatric single mitochondrial DNA deletion disorders: an overlapping spectrum of disease. J Inherit Metab Dis 2015; 38:445-57. [PMID: 25352051 PMCID: PMC4432108 DOI: 10.1007/s10545-014-9778-4] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 09/27/2014] [Accepted: 10/01/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND Single large-scale mitochondrial DNA (mtDNA) deletions (SLSMDs) are amongst the most frequently diagnosed mtDNA disorders in childhood, yet their natural history remains poorly understood. We report the natural history of a large multicentre cohort of such children. METHODS We reviewed case notes from three different UK centres to determine the clinical course of 34 patients (16 female, 18 male) with childhood-onset mitochondrial disease caused by SLSMDs. Kaplan-Meier analysis was used to compare survival of patients presenting with haematological features (Pearson syndrome) and those with nonhaematological presentations. RESULTS The most frequent initial presentation was with isolated ptosis (16/34, 47%). Eleven (32%) patients presented with transfusion-dependent anaemia soon after birth and were diagnosed with Pearson syndrome, whilst ten were classified as having Kearns-Sayre syndrome, three as having progressive external ophthalmoplegia (PEO) and seven as having PEO-plus. Three patients did not conform to any specific mitochondrial syndrome. The most frequently affected organ during the disease course was the kidney, with documented tubular or glomerular dysfunction in 17 of 20 (85%) cases who had detailed investigations. SLSMDs were present in blood and/or urine cells in all cases tested, indicating that muscle biopsy is not necessary for diagnosis in the paediatric age range. Kaplan-Meier survival analysis revealed significantly worse mortality in patients with Pearson syndrome compared with the rest of the cohort. CONCLUSIONS Mitochondrial disease caused by SLSMDs is clinically heterogeneous, and not all cases conform to a classical mitochondrial syndrome. Multisystem disease is the norm, with anaemia, renal impairment and endocrine disturbance being the most frequent extraneurological features. SLSMDs should be considered in the differential diagnosis of all children presenting with ptosis.
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Affiliation(s)
- Alexander Broomfield
- Genetic Medicine, Central Manchester University Hospitals NHS Foundation trust, St Mary’s Hospital, 6th Floor, Oxford Road, Manchester, M 13 9WL UK
| | - Mary G. Sweeney
- Neurogenetics Unit, National Hospital for Neurology & Neurosurgery, Queen Square, London, WC1N 3BG UK
| | - Cathy E. Woodward
- Neurogenetics Unit, National Hospital for Neurology & Neurosurgery, Queen Square, London, WC1N 3BG UK
| | - Carl Fratter
- Oxford Medical Genetics Laboratories, Oxford University Hospitals NHS Trust, The Churchill Hospital, Oxford, OX3 7LE UK
| | - Andrew M. Morris
- Genetic Medicine, Central Manchester University Hospitals NHS Foundation trust, St Mary’s Hospital, 6th Floor, Oxford Road, Manchester, M 13 9WL UK
| | | | - Lara Abulhoul
- Metabolic Unit, Great Ormond Street Hospital NHS Foundation Trust, Institute of Child Health, Great Ormond Street, London, WC1N 3JH UK
| | - Stephanie Grunewald
- Metabolic Unit, Great Ormond Street Hospital NHS Foundation Trust, Institute of Child Health, Great Ormond Street, London, WC1N 3JH UK
- Genetics and Genomic Medicine, UCL Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
| | - Peter T. Clayton
- Genetics and Genomic Medicine, UCL Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
| | - Michael G. Hanna
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG UK
| | - Joanna Poulton
- NDOG, Level 3, Women’s Centre, John Radcliffe Hospital, Oxford, Oxfordshire OX3 9DU UK
| | - Shamima Rahman
- Metabolic Unit, Great Ormond Street Hospital NHS Foundation Trust, Institute of Child Health, Great Ormond Street, London, WC1N 3JH UK
- Genetics and Genomic Medicine, UCL Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
- Mitochondrial Research Group, Genetics and Genomic Medicine, UCL Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
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27
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Abstract
An impairment of eye movements, or nystagmus, is seen in many diseases of the central nervous system, in particular those affecting the brainstem and cerebellum, as well as in those of the vestibular system. The key to diagnosis is a systematic clinical examination of the different types of eye movements, including: eye position, range of eye movements, smooth pursuit, saccades, gaze-holding function and optokinetic nystagmus, as well as testing for the different types of nystagmus (e.g., central fixation nystagmus or peripheral vestibular nystagmus). Depending on the time course of the signs and symptoms, eye movements often indicate a specific underlying cause (e.g., stroke or neurodegenerative or metabolic disorders). A detailed knowledge of the anatomy and physiology of eye movements enables the physician to localize the disturbance to a specific area in the brainstem (midbrain, pons or medulla) or cerebellum (in particular the flocculus). For example, isolated dysfunction of vertical eye movements is due to a midbrain lesion affecting the rostral interstitial nucleus of the medial longitudinal fascicle, with impaired vertical saccades only, the interstitial nucleus of Cajal or the posterior commissure; common causes with an acute onset are an infarction or bleeding in the upper midbrain or in patients with chronic progressive supranuclear palsy (PSP) and Niemann-Pick type C (NP-C). Isolated dysfunction of horizontal saccades is due to a pontine lesion affecting the paramedian pontine reticular formation due, for instance, to brainstem bleeding, glioma or Gaucher disease type 3; an impairment of horizontal and vertical saccades is found in later stages of PSP, NP-C and Gaucher disease type 3. Gaze-evoked nystagmus (GEN) in all directions indicates a cerebellar dysfunction and can have multiple causes such as drugs, in particular antiepileptics, chronic alcohol abuse, neurodegenerative cerebellar disorders or cerebellar ataxias; purely vertical GEN is due to a midbrain lesion, while purely horizontal GEN is due to a pontomedullary lesion. The pathognomonic clinical sign of internuclear ophthalmoplegia is an impaired adduction while testing horizontal saccades on the side of the lesion in the ipsilateral medial longitudinal fascicule. The most common pathological types of central nystagmus are downbeat nystagmus (DBN) and upbeat nystagmus (UBN). DBN is generally due to cerebellar dysfunction affecting the flocculus bilaterally (e.g., due to a neurodegenerative disease). Treatment options exist for a few disorders: miglustat for NP-C and aminopyridines for DBN and UBN. It is therefore particularly important to identify treatable cases with these conditions.
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Scheibye-Knudsen M, Fang EF, Croteau DL, Wilson DM, Bohr VA. Protecting the mitochondrial powerhouse. Trends Cell Biol 2015; 25:158-70. [PMID: 25499735 PMCID: PMC5576887 DOI: 10.1016/j.tcb.2014.11.002] [Citation(s) in RCA: 230] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 11/07/2014] [Accepted: 11/10/2014] [Indexed: 01/21/2023]
Abstract
Mitochondria are the oxygen-consuming power plants of cells. They provide a critical milieu for the synthesis of many essential molecules and allow for highly efficient energy production through oxidative phosphorylation. The use of oxygen is, however, a double-edged sword that on the one hand supplies ATP for cellular survival, and on the other leads to the formation of damaging reactive oxygen species (ROS). Different quality control pathways maintain mitochondria function including mitochondrial DNA (mtDNA) replication and repair, fusion-fission dynamics, free radical scavenging, and mitophagy. Further, failure of these pathways may lead to human disease. We review these pathways and propose a strategy towards a treatment for these often untreatable disorders.
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Affiliation(s)
- Morten Scheibye-Knudsen
- Laboratory of Molecular Gerontology, National Institute on Aging (NIA), National Institutes of Health (NIH), Baltimore, MD 21224, USA
| | - Evandro F Fang
- Laboratory of Molecular Gerontology, National Institute on Aging (NIA), National Institutes of Health (NIH), Baltimore, MD 21224, USA
| | - Deborah L Croteau
- Laboratory of Molecular Gerontology, National Institute on Aging (NIA), National Institutes of Health (NIH), Baltimore, MD 21224, USA
| | - David M Wilson
- Laboratory of Molecular Gerontology, National Institute on Aging (NIA), National Institutes of Health (NIH), Baltimore, MD 21224, USA
| | - Vilhelm A Bohr
- Laboratory of Molecular Gerontology, National Institute on Aging (NIA), National Institutes of Health (NIH), Baltimore, MD 21224, USA.
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Horga A, Pitceathly RDS, Blake JC, Woodward CE, Zapater P, Fratter C, Mudanohwo EE, Plant GT, Houlden H, Sweeney MG, Hanna MG, Reilly MM. Peripheral neuropathy predicts nuclear gene defect in patients with mitochondrial ophthalmoplegia. ACTA ACUST UNITED AC 2014; 137:3200-12. [PMID: 25281868 PMCID: PMC4240292 DOI: 10.1093/brain/awu279] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Mitochondrial ophthalmoplegia is a genetically heterogeneous disorder. Horga et al. investigate whether peripheral neuropathy can predict the underlying genetic defect in patients with progressive external ophthalmoplegia. Results indicate that neuropathy is highly predictive of a nuclear DNA defect and that it is rarely associated with single mitochondrial DNA deletions. Progressive external ophthalmoplegia is a common clinical feature in mitochondrial disease caused by nuclear DNA defects and single, large-scale mitochondrial DNA deletions and is less frequently associated with point mutations of mitochondrial DNA. Peripheral neuropathy is also a frequent manifestation of mitochondrial disease, although its prevalence and characteristics varies considerably among the different syndromes and genetic aetiologies. Based on clinical observations, we systematically investigated whether the presence of peripheral neuropathy could predict the underlying genetic defect in patients with progressive external ophthalmoplegia. We analysed detailed demographic, clinical and neurophysiological data from 116 patients with genetically-defined mitochondrial disease and progressive external ophthalmoplegia. Seventy-eight patients (67%) had a single mitochondrial DNA deletion, 12 (10%) had a point mutation of mitochondrial DNA and 26 (22%) had mutations in either POLG, C10orf2 or RRM2B, or had multiple mitochondrial DNA deletions in muscle without an identified nuclear gene defect. Seventy-seven patients had neurophysiological studies; of these, 16 patients (21%) had a large-fibre peripheral neuropathy. The prevalence of peripheral neuropathy was significantly lower in patients with a single mitochondrial DNA deletion (2%) as compared to those with a point mutation of mitochondrial DNA or with a nuclear DNA defect (44% and 52%, respectively; P < 0.001). Univariate analyses revealed significant differences in the distribution of other clinical features between genotypes, including age at disease onset, gender, family history, progressive external ophthalmoplegia at clinical presentation, hearing loss, pigmentary retinopathy and extrapyramidal features. However, binomial logistic regression analysis identified peripheral neuropathy as the only independent predictor associated with a nuclear DNA defect (P = 0.002; odds ratio 8.43, 95% confidence interval 2.24–31.76). Multinomial logistic regression analysis identified peripheral neuropathy, family history and hearing loss as significant predictors of the genotype, and the same three variables showed the highest performance in genotype classification in a decision tree analysis. Of these variables, peripheral neuropathy had the highest specificity (91%), negative predictive value (83%) and positive likelihood ratio (5.87) for the diagnosis of a nuclear DNA defect. These results indicate that peripheral neuropathy is a rare finding in patients with single mitochondrial DNA deletions but that it is highly predictive of an underlying nuclear DNA defect. This observation may facilitate the development of diagnostic algorithms. We suggest that nuclear gene testing may enable a more rapid diagnosis and avoid muscle biopsy in patients with progressive external ophthalmoplegia and peripheral neuropathy.
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Affiliation(s)
- Alejandro Horga
- 1 MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - Robert D S Pitceathly
- 1 MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - Julian C Blake
- 2 Department of Clinical Neurophysiology, Norfolk and Norwich University Hospital, Norwich, NR4 7UY, UK
| | - Catherine E Woodward
- 3 Neurogenetics Unit, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - Pedro Zapater
- 4 Clinical Pharmacology Section, Hospital General Universitario, Alicante, 03010, Spain
| | - Carl Fratter
- 5 Oxford Medical Genetics Laboratories, Oxford University Hospitals NHS Trust, Oxford, OX3 7LE, UK
| | - Ese E Mudanohwo
- 3 Neurogenetics Unit, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - Gordon T Plant
- 6 National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - Henry Houlden
- 1 MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - Mary G Sweeney
- 3 Neurogenetics Unit, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - Michael G Hanna
- 1 MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - Mary M Reilly
- 1 MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
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30
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Galetta F, Franzoni F, Mancuso M, Orsucci D, Tocchini L, Papi R, Speziale G, Gaudio C, Siciliano G, Santoro G. Cardiac involvement in chronic progressive external ophthalmoplegia. J Neurol Sci 2014; 345:189-92. [DOI: 10.1016/j.jns.2014.07.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 07/20/2014] [Accepted: 07/21/2014] [Indexed: 11/30/2022]
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31
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Domenis DR, Granzotti RB, Sobreira CF, Dantas RO. Pharyngeal transit in patients with chronic progressive external ophthalmoplegia. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2014; 17:384-389. [PMID: 25142449 DOI: 10.3109/17549507.2014.941935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE A common presentation of mitochondrial myopathies is chronic progressive external ophthalmoplegia (CPEO). Dysphagia is a complaint in about 50% of cases. METHOD This investigation evaluated pharyngeal transit in patients with CPEO. Videofluoroscopic swallowing evaluation was performed with paste, liquid and solid boluses in 14 patients with CPEO and in 16 normal volunteers. RESULT There was no difference between patients and volunteers in the duration of pharyngeal swallowing events with the liquid bolus. Compared to control participants, patients with CPEO had significantly shorter duration of pharyngeal transit for paste and solid boluses, of pharyngeal clearance for paste bolus, and of upper oesophageal sphincter transit for paste and solid boluses. Spontaneous multiple swallows and effortful swallows were performed by patients but not by the volunteers. CONCLUSION It was concluded that patients with CPEO have shorter pharyngeal transit duration of paste and solid boluses than normal volunteers, which may be a consequence of a spontaneous smaller bolus volume in each swallow and/or effortful swallows.
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32
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Grady JP, Campbell G, Ratnaike T, Blakely EL, Falkous G, Nesbitt V, Schaefer AM, McNally RJ, Gorman GS, Taylor RW, Turnbull DM, McFarland R. Disease progression in patients with single, large-scale mitochondrial DNA deletions. Brain 2013; 137:323-34. [PMID: 24277717 PMCID: PMC3914470 DOI: 10.1093/brain/awt321] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Single, large-scale deletions of mitochondrial DNA are a common cause of mitochondrial disease and cause a broad phenotypic spectrum ranging from mild myopathy to devastating multi-system syndromes such as Kearns-Sayre syndrome. Studies to date have been inconsistent on the value of putative predictors of clinical phenotype and disease progression such as mutation load and the size or location of the deletion. Using a cohort of 87 patients with single, large-scale mitochondrial DNA deletions we demonstrate that a variety of outcome measures such as COX-deficient fibre density, age-at-onset of symptoms and progression of disease burden, as measured by the Newcastle Mitochondrial Disease Adult Scale, are significantly (P < 0.05) correlated with the size of the deletion, the deletion heteroplasmy level in skeletal muscle, and the location of the deletion within the genome. We validate these findings with re-analysis of 256 cases from published data and clarify the previously conflicting information of the value of these predictors, identifying that multiple regression analysis is necessary to understand the effect of these interrelated predictors. Furthermore, we have used mixed modelling techniques to model the progression of disease according to these predictors, allowing a better understanding of the progression over time of this strikingly variable disease. In this way we have developed a new paradigm in clinical mitochondrial disease assessment and management that sidesteps the perennial difficulty of ascribing a discrete clinical phenotype to a broad multi-dimensional and progressive spectrum of disease, establishing a framework to allow better understanding of disease progression.
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Affiliation(s)
- John P Grady
- 1 Wellcome Trust Centre for Mitochondrial Research, Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
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Pinto M, Moraes CT. Mitochondrial genome changes and neurodegenerative diseases. Biochim Biophys Acta Mol Basis Dis 2013; 1842:1198-207. [PMID: 24252612 DOI: 10.1016/j.bbadis.2013.11.012] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 11/06/2013] [Accepted: 11/08/2013] [Indexed: 12/12/2022]
Abstract
Mitochondria are essential organelles within the cell where most of the energy production occurs by the oxidative phosphorylation system (OXPHOS). Critical components of the OXPHOS are encoded by the mitochondrial DNA (mtDNA) and therefore, mutations involving this genome can be deleterious to the cell. Post-mitotic tissues, such as muscle and brain, are most sensitive to mtDNA changes, due to their high energy requirements and non-proliferative status. It has been proposed that mtDNA biological features and location make it vulnerable to mutations, which accumulate over time. However, although the role of mtDNA damage has been conclusively connected to neuronal impairment in mitochondrial diseases, its role in age-related neurodegenerative diseases remains speculative. Here we review the pathophysiology of mtDNA mutations leading to neurodegeneration and discuss the insights obtained by studying mouse models of mtDNA dysfunction.
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Affiliation(s)
- Milena Pinto
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL 33136, USA; Department of Cell Biology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Carlos T Moraes
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL 33136, USA; Neuroscience Graduate Program, University of Miami Miller School of Medicine, Miami, FL 33136, USA; Department of Cell Biology, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
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34
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Spendiff S, Reza M, Murphy JL, Gorman G, Blakely EL, Taylor RW, Horvath R, Campbell G, Newman J, Lochmüller H, Turnbull DM. Mitochondrial DNA deletions in muscle satellite cells: implications for therapies. Hum Mol Genet 2013; 22:4739-47. [PMID: 23847047 PMCID: PMC3820134 DOI: 10.1093/hmg/ddt327] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Progressive myopathy is a major clinical feature of patients with mitochondrial DNA (mtDNA) disease. There is limited treatment available for these patients although exercise and other approaches to activate muscle stem cells (satellite cells) have been proposed. The majority of mtDNA defects are heteroplasmic (a mixture of mutated and wild-type mtDNA present within the muscle) with high levels of mutated mtDNA and low levels of wild-type mtDNA associated with more severe disease. The culture of satellite cell-derived myoblasts often reveals no evidence of the original mtDNA mutation although it is not known if this is lost by selection or simply not present in these cells. We have explored if the mtDNA mutation is present in the satellite cells in one of the commonest genotypes associated with mitochondrial myopathies (patients with single, large-scale mtDNA deletions). Analysis of satellite cells from eight patients showed that the level of mtDNA mutation in the satellite cells is the same as in the mature muscle but is most often subsequently lost during culture. We show that there are two periods of selection against the mutated form, one early on possibly during satellite cell activation and the other during the rapid replication phase of myoblast culture. Our data suggest that the mutations are also lost during rapid replication in vivo, implying that strategies to activate satellite cells remain a viable treatment for mitochondrial myopathies in specific patient groups.
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Affiliation(s)
- Sally Spendiff
- Wellcome Trust Centre for Mitochondrial Research, The Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
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35
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Zhao D, Wang Z, Hong D, Zhang W, Yuan Y. Chronic progressive external ophthalmoplegia coexistent with motor neuron disease in a patient with a novel large-scale mitochondrial DNA deletion. Clin Neurol Neurosurg 2012; 115:1490-2. [PMID: 23266267 DOI: 10.1016/j.clineuro.2012.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 11/17/2012] [Accepted: 11/20/2012] [Indexed: 11/18/2022]
Affiliation(s)
- Danhua Zhao
- Department of Neurology, Peking University First Hospital, Beijing 100034, PR China
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36
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Pfeffer G, Mezei MM. Cardiac screening investigations in adult-onset progressive external ophthalmoplegia patients. Muscle Nerve 2012; 46:593-6. [PMID: 22987704 DOI: 10.1002/mus.23538] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Patients with mitochondrial myopathies may develop cardiac complications such as cardiomyopathy and/or cardiac conduction defects. To identify these potentially life-threatening and treatable conditions, it is common practice to screen patients intermittently with electrocardiography and echocardiography. The optimal time interval for such screening investigations is unknown. We developed this study to review our screening results in adult-onset patients with progressive external ophthalmoplegia (PEO). METHODS This study was a retrospective review of PEO patients with 5 years or more of cardiac screening investigations who did not have any cardiac symptoms. RESULTS Fifteen patients were included, and cardiomyopathy was identified on screening echocardiogram in 1 patient. Four patients had other abnormalities identified, which were unrelated to their mitochondrial myopathy. CONCLUSIONS Only 1 patient in 15 developed cardiac complications related to mitochondrial disease during 5 years of follow-up. We suggest that a screening interval of 3-5 years is probably appropriate for adult-onset PEO patients who do not have cardiac symptoms.
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Affiliation(s)
- Gerald Pfeffer
- Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
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37
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Abstract
The mitochondrial DNA (mtDNA) is a compact genome inherited through the maternal lineage. Mutations in mtDNA lead to many of the earliest identified syndromic mitochondrial diseases and display a diverse range of age of onset, symptoms, and outcomes-from isolated childhood onset vision or hearing loss to a multisystemic neurodegenerative disorder with strokes, neuropathy, ophthalmoparesis, and epilepsy beginning at any age. As a heterogeneous group, mitochondrial diseases represent one of the most common metabolic disorders in children and adults, frequently seen by both pediatric and adult specialists. Although the myriad of diseases can make diagnosis seems daunting, the need for extensive supportive care and treatment (the latter for at least a select few mitochondrial disorders) and a rapid and accurate recognition of these disorders is necessary. Here, we provide a review of the most common mitochondrial disease syndromes due to mtDNA mutations.
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Affiliation(s)
- Suzanne Debrosse
- Center for Human Genetics, University Hospitals, Case Medical Center, Cleveland, OH 44195, USA
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38
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Domenis DR, Okubo PMCI, Sobreira C, Dantas RO. Esophageal contractions in patients with chronic progressive external ophthalmoplegia. Dig Dis Sci 2011; 56:2343-8. [PMID: 21399928 DOI: 10.1007/s10620-011-1631-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Accepted: 02/14/2011] [Indexed: 12/09/2022]
Abstract
BACKGROUND Chronic progressive external ophthalmoplegia is a mitochondrial myopathy that causes muscular or multisystem symptoms and has dysphagia as one manifestation. AIM To evaluate esophageal contractions in patients with chronic progressive external ophthalmoplegia. METHODS We studied 14 patients with chronic progressive external ophthalmoplegia and 16 asymptomatic volunteers. The diagnosis of the disease was established by the clinical picture and by mitochondrial DNA analysis in skeletal muscle. We used the manometric method with a perfusion catheter that recorded the esophageal contractions at 2, 7, 12, 17, and 22 cm from the lower esophageal sphincter (LES). All subjects performed in the supine position 20 swallows of a 5-ml bolus of water at room temperature, ten every 30 s and ten every 10 s. RESULTS The amplitude, duration, and area under the curve of contractions at 17 and 22 cm from the LES were lower in patients than in volunteers for swallows performed at 10-s and 30-s intervals (P<0.01). There was no difference in contractions at 7 and 2 cm, except for the contractions at 2 cm after swallows performed at 30-s intervals. The interval between the onset of contractions between 7 and 2 cm and between 22 and 2 cm was lower in patients than in volunteers, with swallows performed every 10 s and every 30 s. CONCLUSION There is impairment of esophageal contractions in patients with chronic progressive external ophthalmoplegia, mainly in the proximal esophageal body.
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Affiliation(s)
- Danielle Ramos Domenis
- Medical School of Ribeirão Preto, University of São Paulo, and Department of Ophthalmology, Otolaryngology and Head and Neck Surgery, University Hospital of Ribeirão Preto USP, Ribeirão Preto, SP, Brazil.
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Smits BW, Heijdra YF, Cuppen FWA, van Engelen BGM. Nature and frequency of respiratory involvement in chronic progressive external ophthalmoplegia. J Neurol 2011; 258:2020-5. [PMID: 21533826 PMCID: PMC3214610 DOI: 10.1007/s00415-011-6060-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 04/12/2011] [Accepted: 04/12/2011] [Indexed: 11/03/2022]
Abstract
Chronic progressive external ophthalmoplegia (CPEO) is a relatively common mitochondrial disorder. Weakness of the extra-ocular, limb girdle and laryngeal muscles are established clinical features. Respiratory muscle involvement however has never been studied systematically, even though respiratory complications are one of the main causes of death. We therefore determined the prevalence and nature of respiratory muscle involvement in 23 patients with genetically confirmed CPEO. The main finding was decreased respiratory muscle strength, both expiratory (76.8% of predicted, p = 0.002) and inspiratory (79.5% of predicted, p = 0.004). Although the inspiratory vital capacity (92.5% of predicted, p = 0.021) and the forced expiratory volume in 1 s (89.3% of predicted, p = 0.002) were below predicted values, both were still within the normal range in the majority of patients. Expiratory weakness was associated with a decreased vital capacity (ρ = 0.502, p = 0.015) and decreased peak expiratory flow (ρ = 0.422, p = 0.045). Moreover, expiratory muscle strength was lower in patients with limb girdle weakness (62.6 ± 26.1% of predicted vs. 98.9 ± 22.5% in patients with normal limb girdle strength, p = 0.003), but was not associated with other clinical features, subjective respiratory complaints, disease severity or disease duration. Since respiratory involvement in CPEO is associated with severe morbidity and mortality, the present data justify periodic assessment of respiratory functions in all CPEO patients.
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Affiliation(s)
- Bart W Smits
- Neuromuscular Centre Nijmegen, Department of Neurology, Radboud University Nijmegen Medical Centre, Reinier Postlaan 4, 6500 HB Nijmegen, The Netherlands.
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Smits BW, Fermont J, Delnooz CC, Kalkman JS, Bleijenberg G, van Engelen BG. Disease impact in chronic progressive external ophthalmoplegia: More than meets the eye. Neuromuscul Disord 2011; 21:272-8. [DOI: 10.1016/j.nmd.2010.12.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Revised: 11/09/2010] [Accepted: 12/15/2010] [Indexed: 11/25/2022]
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A Novel Heteroplasmic tRNASer(UCN) mtDNA Point Mutation Associated With Progressive Ophthalmoplegia and Dysphagia. ACTA ACUST UNITED AC 2010; 19:28-32. [DOI: 10.1097/pdm.0b013e3181b00f02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Blackwood JK, Whittaker RG, Blakely EL, Alston CL, Turnbull DM, Taylor RW. The investigation and diagnosis of pathogenic mitochondrial DNA mutations in human urothelial cells. Biochem Biophys Res Commun 2010; 393:740-5. [PMID: 20171163 DOI: 10.1016/j.bbrc.2010.02.072] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 02/11/2010] [Indexed: 01/23/2023]
Abstract
Patients with mitochondrial DNA disease are amongst the most challenging to diagnose and manage given the striking phenotypic and genetic heterogeneity, which characterise these conditions. Recently, we and others have demonstrated the m.3243A>G mutation, one of the most common mitochondrial DNA pathogenic mutations, is present at clinically relevant levels in urinary epithelium, thus providing a practical, non-invasive test for diagnosis and mutation screening. In this study we further evaluate the use of these cells in detecting the m.3243A>G mutation, other mtDNA tRNA gene point mutations including the m.8344A>G mutation and single large-scale mtDNA deletions. We observe a robust relationship between m.3243A>G levels in urothelial cells and clinically affected tissues that does not change with time. Conversely, single large-scale mtDNA deletions can be detected in urothelial cells, with higher levels present in younger patients with more severe disease, but generally mtDNA deletion levels are not representative of those seen in a clinically affected tissue. Our results have implications for the diagnosis, management and counselling of families with mtDNA disease.
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Affiliation(s)
- John K Blackwood
- Mitochondrial Research Group, Institute for Ageing and Health, The Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
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CPEO and KSS differ in the percentage and location of the mtDNA deletion. Mitochondrion 2009; 9:314-7. [DOI: 10.1016/j.mito.2009.04.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Revised: 04/15/2009] [Accepted: 04/23/2009] [Indexed: 01/15/2023]
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Yamashita S, Nishino I, Nonaka I, Goto YI. Genotype and phenotype analyses in 136 patients with single large-scale mitochondrial DNA deletions. J Hum Genet 2008; 53:598. [PMID: 18414780 DOI: 10.1007/s10038-008-0289-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2008] [Accepted: 03/17/2008] [Indexed: 10/22/2022]
Abstract
We examined 136 patients with mitochondrial DNA (mtDNA) deletion. Clinical diagnoses included chronic progressive external ophthalmoplegia (94 patients); Kearns-Sayre syndrome (KSS; 33 patients); Pearson's marrow-pancreas syndrome (six patients); and Leigh syndrome, Reye-like syndrome, and mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (one patient). The length and location of deletion were highly variable. Only one patient had deletion within the so-called shorter arc between the two origins of mtDNA replication. The length of deletion and the number of deleted transfer ribonucleic acid (tRNAs) showed a significant relationship with age at onset. Furthermore, KSS patients had longer and larger numbers of deleted tRNAs, which could be risk factors for the systemic involvement of single mtDNA deletion diseases. We found 81 patterns of deletion. Direct repeats of 4 bp or longer flanking the breakpoints were found in 96 patients (70.5%) and those of 10 bp or longer in 49 patients (36.0%). We found two other common deletions besides the most common deletion (34 patients: 25.0%): the 2,310-bp deletion from nt 12113 to nt 14421 (11 patients: 8.0%) and the 7,664-bp deletion from nt 6330 to nt 13993 (ten patients: 7.3%). These deletions had incomplete direct repeats longer than 13 bp with one base mismatch.
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Affiliation(s)
- Shintaro Yamashita
- Department of Mental Retardation and Birth Defect Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), 4-1-1 Ogawahigashi, Kodaira, Tokyo, 187-8502, Japan.,Department of Pediatrics and Adolescent Medicine, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Kodaira, Tokyo, Japan
| | - Ikuya Nonaka
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Kodaira, Tokyo, Japan
| | - Yu-Ichi Goto
- Department of Mental Retardation and Birth Defect Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), 4-1-1 Ogawahigashi, Kodaira, Tokyo, 187-8502, Japan.
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Dynamic properties of eye movements in mitochondrial chronic progressive external ophthalmoplegia. Eye (Lond) 2007; 23:382-8. [PMID: 17962819 DOI: 10.1038/sj.eye.6703024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
AIMS To relate dynamic properties of eye movements to visual disability in a patient with chronic progressive external ophthalmoplegia (CPEO) due to mitochondrial DNA deletion. METHODS Visual function was evaluated by neuro-ophthalmological examination and visual function index (VF-14). Eye movements were measured using the magnetic search coil technique. RESULTS The patient denied diplopia or oscillopsia at rest or during locomotion. His range of eye movements was limited to <12 degrees horizontally, and <19 degrees vertically with smaller movements of the left eye. All classes of movements were impaired, but the eyes accelerated to over 1000 degrees /s/s at the onset of saccades and in response to brisk head rotations. CONCLUSIONS Diplopia and oscillopsia were suppressed, probably due to visual system adaptation during the slow disease progression. We postulate that relative sparing of pale global extraocular fibres accounted for preserved acceleration of saccades and vestibular eye movements.
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